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Disorders of the Stomach High Yield Flashcards

1
Q

Hallmark sign of stomach disorder

A

Dyspepsia

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2
Q

3 main etiologies for erosive gastritis

A
  1. Meds (NSAIDs)
  2. Alcohol
  3. Stress
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3
Q

MC clinical manifestation of erosive gastritis

A

Upper GI Bleeding

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4
Q

Most sensitive method of diagnosing erosive gastritis

A

EGD

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5
Q

Tx of erosive gastritis

A
  1. Remove any causative agent
  2. Pantoprazole 80mg bolus + 8mg/hr infusion
  3. EGD within 24hrs
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6
Q

What EGD findings suggest erosive gastritis?

A
  1. Erythema
  2. Red/black mucosal lesions
  3. Petechial hemorrhages
  4. Presence of blood vessels
  5. Absence of rugal folds
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7
Q

Tx of NSAID gastritis

A

PPIs +/- sucralfate +/- celebrex

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8
Q

Best way to treat/prevent ulcers

A

PPIs

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9
Q

3 main etiologies for NONerosive gastritis?

A
  1. H pylori
  2. NSAIDs
  3. Autoimmune gastritis
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10
Q

MC demographic for H pylori infection

A

Children in crowded areas w/ poor sanitation

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11
Q

What 3 demographics have the most susceptibility to gastric metaplasia?

A
  • Hispanics
  • Native Americans
  • African Americans
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12
Q

Diagnosis of non-erosive gastritis

A

EGD w/ biopsy

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13
Q

Workup for pts < 60 w/o uncomplicated dyspepsia

A

Check for H. pylori via urea breath or fecal antigen.

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14
Q

Criteria to workup pt for non-erosive gastritis with EGD

A
  1. > 60 w/ new onset dyspepsia
  2. Young pts with alarm symptoms
  3. Failure of initial therapy
  4. FMHx of gastric cancer
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15
Q

Positive urea breath test

A

Expired CO2 contains tagged urea isotope

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16
Q

What antibody class is most useful for monitoring H pylori treatment?

A

IgG

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17
Q

1st therapy for H. pylori eradication

A
  1. PPI 20mg BID
  2. Clarithomycin 500mg BID
  3. Amoxicillin 1g BID

Please Cure Abdomen

10-14 days

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18
Q

2nd line therapy for H. pylori eradication

A
  1. PPI
  2. Metronidazole 500mg TID
  3. Tetracycline 500mg QID
  4. Bismuth 300mg QID

Please Make Tummy Better

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19
Q

What two spots does PUD occur in?

A
  • Duodenum
  • Stomach
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20
Q

Age range for stomach PUD

A

55-70

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21
Q

Age range for duodenal PUD

A

30-55

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22
Q

What layer is PUD

A

muscularis mucosa

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23
Q

3 main etiologies for PUD

A
  • H pylori (Duodenum)
  • NSAIDs (Stomach)
  • Zollinger Ellison
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24
Q

4 PUD risk factors

A
  1. NSAIDs
  2. Age > 60
  3. Prior PUD or H pylori
  4. Smoking
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25
Hallmark signs of PUD
1. Epigastric, gnawing pain that **relieves with eating** 2. Nocturnal pain that wakes patient | 11pm-3am MC time
26
Diagnosis of PUD
EGD with gastric mucosal biopsy
27
Noninvasive testing using fecal antigen or urea breath test criteria for PUD
1. < 60 w/o no alarm 2. Hx of PUD to diagnose active infections 3. Checking post-treatment 4. Biopsy inconclusive/not done w/ EGD
28
Tx of PUD due to H. pylori
1st line H. pylori eradication tx for 10-14d 1. PPI 20mg BID 2. Clarithomycin 500mg BID 3. Amoxicillin 1g BID | Please Cure Abdomen
29
How to confirm H. pylori eradication?
EGD or urea breath test 4 weeks post therapy
30
Criteria to CONTINUE meds post eradication therapy
* Large ulcer > 2cm * Failed eradication * Recurrent ulcers * Continued NSAID use | Continue PPI for 4-6 weeks more
31
Patient wants to continue NSAID even though they have NSAID induced PUD. Tx?
* Use PPI as long as NSAID is used * Use celebrex instead
32
MCC of UGI bleed
PUD
33
Initial managment of a GI Bleed
Fluids and stabilize hemodynamic state
34
1st med to give IV in GI bleed
PPI
35
Hallmark sign of PUD w/ perforation
Sudden, severe abd pain
36
Diagnosis of perforation
CT Abd showing free air in anterior peritoneal space or under diaphragm
37
Management of PUD w/ perf
PPIs and surgery if not improved.
38
Tx of gastric outlet obstruction
1. IV PPI 2. EGD 3. Dilation via balloons
39
Misoprostol MOA and BBW
* MOA: Replace prostaglandins * BBW: will terminate pregnancy if taken
40
MC SE of misoprostol
Diarrhea
41
What should be screened for prior to misoprostol administration?
Pregnancy test 2 weeks prior
42
Sucralfate MOA and MC SE
* MOA: Increased prostaglandin synthesis * SE: Constipation and affects absorption of other drugs
43
Etiology of gastric outlet obstruction in babies
Postnatal hypertrophy of pylorus
44
Hallmark symptoms of gastric outlet obstruction in adults? Infants?
* Adults: Postprandial N/V * Infants: Projectile vomiting
45
PE Findings for adult for gastric outlet obstruction? Infants?
* Adults: distension, tenderness, succussion splash * Infants: distension, olive shaped mass in UR abd post-emesis, dehydration
46
Diagnosis of adult gastric outlet obstruction? Infants?
* Adults: EGD + CT * Infants: Abd US
47
Adult management of gastric outlet obstruction?
* NPO, fluids, NG tube, PPI * Pyloromyotomy if surgery needed
48
MC demographics for gastroparesis
* Women * Diabetics
49
PE Findings in gastroparesis
* Possible distension or tenderness * No guarding or rigidity * Possible succussion splash
50
Diagnosis of gastroparesis
Gastric emptying test
51
Management of gastroparesis
* Low fat diet * Metoclopramide or erythromycin * Treat underlying cause
52
Positive gastric emptying test result
> 10% retention after 4 hours
53
Triad of Zollinger Ellison
1. Gastrinomas (Pancreas or duodenum) 2. Gastric acid hypersecretion 3. Peptic ulcers
54
Majority of zollinger-ellison ulcers are...
Malignant
55
Classic presentation of Zollinger-Ellison
* Refractory PUD * Heartburn * Wt loss * Diarrhea
56
Diagnosis of Zollinger Ellison
1. Serum gastrin level > 10x ULN with pH < 2 2. Positive gastrin must be confirmed with secretin stimulation | No PPIs 6 days prior
57
Imaging modalities for Zollinger Ellison
* CT/MRI to find tumors and mets * Somatostatin receptor scintigraphy to find primary tumor
58
2 MC sites of mets for Zollinger Ellison
1. Liver (MC) 2. Bones
59
How to improve Zollinger-Ellison survival
Resect liver mets
60
Benign vs malignant gastric tumors
* Benign: polyps * Malignant: adenocarcinoma (MC), lymphoma, carcinoid (zollinger-ellison)
61
MC type of gastric cancer
Adenocarcinoma | Gland cells in stomach
62
MC subtype of adenocarcinoma
Intestinal type adenocarcinoma
63
3 mets sites (nodes) for adenocarcinoma
1. L supraclavicular lymph node (Virchow's) 2. Umbilical nodule (Sister mary joseph) 3. Rigid rectal shelf (Blumer shelf)
64
Diagnosis of gastric adenocarcinoma
EGD w/ biopsy | CT for mets
65
Tx of gastric adenocarcinomas
1. Resect 2. Chemo/radiation
66
MC risk factor for gastric lymphoma
Chronic H. Pylori infection
67
Diagnosis of gastric lymphoma
EGD w/ biopsy

GI (17 decks)

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